Streptococcus pneumoniae meningo-encephalitis after trans-sphenoidal surgery: a case report.

Although meningismus or meningitis are known to occur after pituitary surgery; meningo-encephalitis caused by Streptococcus pneumoniae following a trans-sphenoidal approach has not been previously reported. A 56-year-old man presented with blurred vision. Two days after uneventful surgery, the patient became hyperpyrexic which progressed to confusion and lethargy within 48 hours. Spinal fluid cultures revealed Streptococcus pneumoniae. The patient was treated appropriately and made an uneventful recovery. MR images showed persistent changes within both frontal lobes. This case further suggests that peri-operative antimicrobial chemoprophylaxis may not save the patient from serious surgical infections.